One of the national health objectives for 2000 (HP2000) is to
establish and monitor nonoccupational "sentinel" environmental
diseases,
including asthma, heatstroke, hypothermia, heavy metal poisoning,
pesticide
poisoning, carbon monoxide poisoning, acute chemical poisoning, and
methemoglobinemia, in at least 35 states (baseline: 0 states in
1990)
(objective 11.16) (1). To assess progress toward this objective,
the
Council of State and Territorial Epidemiologists (CSTE), the
Association of
Schools of Public Health, and CDC conducted a telephone survey of
environmental epidemiologists in each of the 50 states, the
District of
Columbia, and Puerto Rico during June-August 1997. This report
summarizes
the results of that survey, which indicate that progress is being
made
toward the HP2000 objective.

Approximately 2-3 weeks before the telephone survey was
conducted, a
questionnaire on environmental disease surveillance systems in each
jurisdiction was sent to the epidemiologist responsible for
environmental
health to allow time for gathering of information. The
questionnaire
inquired about each jurisdiction's surveillance activities, sources
of
surveillance data, funding, and goals. Each jurisdiction was asked
to
describe its surveillance activities from among the following: data
collection only; data collection and review; or data collection,
review,
and case investigation. No additional definitions were provided,
and
interpretation of the three classifications was left to the
respondent.

Responses were obtained from all 52 environmental
epidemiologists. The
telephone survey identified 174 environmental public health
surveillance
systems from 51 jurisdictions. The mean number of systems per
jurisdiction
was three; the median was two (range: zero to 12) (Figure_1).
Of the
174, a total of 79 (45%) systems monitored lead exposure, with most
systems
monitoring childhood blood lead levels (BLLs) (51 {65%} of 79). The
remaining 28 systems monitored nonoccupational adult lead
exposures. The
environmental diseases least frequently monitored were heatstroke
and
hypothermia (four systems each) (Table_1). One jurisdiction
(Missouri)
had surveillance systems for all 12 of the environmental public
health
conditions covered by the survey. One jurisdiction did not have any
surveillance systems.

Using the description for each disease monitoring system
described in
this report, 15 (9%) of the surveillance systems collected data
only, 46
(27%) collected data and conducted reviews, and 110 (64%) collected
data
and conducted both reviews and case investigations. Asthma was the
only
condition for which no systems conducted case investigations.

Sources of Data

Data about environmental disease surveillance were collected
from
numerous sources. Of the 79 lead exposure surveillance systems, 76
(96%)
provided information about primary source of data. Of these, 71
(93%) used
laboratory data as the primary source of information. Laboratory
reporting
was mandatory in jurisdictions covered by 65 (86%) of 76 systems.
Data
about BLLs were gathered electronically by 35 (46%) systems. Five
lead
surveillance systems used electronic reporting exclusively.

Of the remaining 95 nonlead environmental disease surveillance
systems, three did not provide information about primary source of
data.
The sources of data for the other 92 systems included laboratories
(37
{40%}), clinicians (19 {21%}), hospitals (14 {15%}), poison-control
centers
(seven {8%}), and other sources (15 {16%}). Laboratory reporting
was
mandatory in the jurisdictions covered by 27 (72%) of 37 systems
gathering
data from laboratories, and reporting by clinicians was mandatory
in 15
(79%) of the 19 systems gathering data from clinicians. No nonlead
surveillance systems received information electronically.

Funding

Thirty-six (71%) of 51 childhood lead monitoring systems and
14 (50%)
of 28 adult lead monitoring systems were either entirely or largely
dependent on federal funds for their operation. Twenty-one (23%) of
95
nonlead environmental disease monitoring systems received any
federal
funding.

Editorial Note

Editorial Note: The findings in this report indicate that childhood
lead
poisoning was the only "sentinel environmental disease" for which
HP2000
objective 11.16 has been achieved (1). Although not every system
met the
requirement to be identified as a surveillance system (ongoing
collection,
analysis, and use of health data), most of the childhood lead
monitoring
systems collected, reviewed, and took appropriate action based on
the data.

The findings in this report are subject to at least two
limitations.
First, jurisdiction-based surveillance systems can have different
case
definitions. For example, although CDC recommends using BLLs
greater than
or equal to 10 ug/dL to identify children with elevated BLLs, some
jurisdictions used higher values. Jurisdiction-specific case
definitions
may be necessary because of limited resources and other
considerations.
CDC, in collaboration with other agencies and organizations, is
developing
definitions for several environmental diseases such as carbon
monoxide
poisoning and asthma. Using a standard case definition may allow
data from
numerous jurisdictions to be more easily summarized and compared.
However,
each jurisdiction will base its environmental health priorities on
its own
needs and available resources. Second, greater than 90% of the
systems
identified in the 1997 survey reviewed the data collected, and in
most
cases implemented activities based on the data. This survey did not
collect
information about the frequency or extent of data review or of
follow-up
activities. Usefulness of routinely collected environmental disease
data
depends on timely analysis of the data followed by dissemination of
information to persons who "need to know," such as policy makers
and
program managers (2-7).

Surveillance systems should be simple, sensitive,
representative, and
timely to be most effective in controlling and preventing disease
(8).
Surveillance systems at the local, state, and national levels are
useful
for assessing case investigations, implementing control activities,
evaluating interventions, monitoring trends, and identifying risk
factors.
A comprehensive integrated public health surveillance system that
combines
local, state, and national surveillance activities can best achieve
the
primary goal of public health surveillance, namely a reduction in
disease
morbidity and mortality (3). Progress toward the HP2000 objective
is
evident from the results of this survey. Adequate resources and
increased
public awareness about the value of surveillance systems in
preventing and
controlling disease are necessary to fully achieve the objective
(2).

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